We read with interest the Correspondence from Noemi García-Tardón and colleagues (Sept 23, 2017, p 1485) 1 describing the prevalence of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among blood donors in Sierra Leone. Considering there are few data on viral hepatitis from the region, the authors should be congratulated for their efforts. However, we fear that some of their results and messages might be misleading.

2. [Department of Error] Department of Error

The Lancet, 8.12.2017Tilføjet 16.03.2018 06:39

Williams R, Alexander G, Armstrong I, et al. Disease burden and costs from excess alcohol consumption, obesity, and viral hepatitis: fourth report of the Lancet Standing Commission on Liver Disease in the UK. Lancet 2018; 391: 1097–107—In this Health Policy (published online first on Nov 29, 2017), the first sentence in the legend of figure 4 should read “Data are from references 31 and 32 and were categorised into 5 year bands.” This correction has been made to the online version as of Dec 7, 2017, and the printed Health Policy is correct.

3. A Shift in Thinking to Reduce Mother-to-Infant Transmission of Hepatitis B

The morbidity and mortality that are associated with hepatitis B virus (HBV) infection have been overshadowed by the public health prominence of other infectious diseases, including human immunodeficiency virus (HIV) infection, tuberculosis, and malaria. There is a dawning realization that the…

In China, the epidemic pattern of acute hepatitis E virus (HEV) infection has changed from waterborne outbreaks to foodborne sporadic cases. However, the clinical course of sporadic acute hepatitis E has not been well defined.

AbstractBackgroundThe hepatitis B virus (HBV) surface proteins (HBsAg) coat the viral particle and form subviral particles (SVPs). Loss of HBsAg represents a functional cure and is an important treatment goal.MethodsWe analyzed the impact of the HBV genotypes A-E and pre-S mutations on SVP expression in HBeAg negative chronic HBV infected patients. A HBV genome harboring a preS1-deletion was analyzed in hepatoma cells.ResultsWe observed a genotype-specific ratio of the three surface proteins (SHBs/MHBs/LHBs), which reflects differences in the morphology and composition of SVPs. Deletions/mutations in the preS1/preS2 domain, detected in released viral genomes, did not affect the molecular weight of MHBs and LHBs in these patients. In contrast, LHBs molecular weight was altered in vitro using a HBV genome harboring a preS1-deletion derived from one of these patients.ConclusionDifferences in composition of SVPs may result in a genotype-specific immunogenicity and pathogenesis. In the analyzed patients with preS-mutations secreted HBsAg and released viral genomes cannot be derived from the same genetic source. As viral genomes are derived from cccDNA, HBsAg is presumably derived from the integrated DNA. This important HBsAg source has to be considered for novel antiviral strategies in HBeAg negative chronic HBV infected patients.

9. Hepatotoxicity during Isoniazid Preventive Therapy and Antiretroviral Therapy in People Living with HIV with Severe Immunosuppression: a Secondary Analysis of a Multi-country Open-label Randomized Controlled Clinical Trial

Background
The European AIDS Clinical Society (EACS) Guidelines have since 2005 provided multidisciplinary recommendations for the care of HIV‐positive persons in geographically diverse areas.
Guideline highlights
Major revisions have been made in all sections of the 2017 Guidelines: antiretroviral treatment (ART), comorbidities, coinfections and opportunistic diseases. Newly added are also a summary of the main changes made, and direct video links to the EACS online course on HIV Management. Recommendations on the clinical situations in which tenofovir alafenamide may be considered over tenofovir disoproxil fumarate are provided, and recommendations on which antiretrovirals can be used safely during pregnancy have been revised. Renal and bone toxicity and hepatitis C virus (HCV) treatment have been added as potential reasons for ART switches in fully virologically suppressed individuals, and dolutegravir/rilpivirine has been included as a treatment option. In contrast, dolutegravir monotherapy is not recommended. New recommendations on non‐alcoholic fatty liver disease, chronic lung disease, solid organ transplantation, and prescribing in elderly are included, and human papilloma virus (HPV) vaccination recommendations have been expanded. All drug–drug interaction tables have been updated and new tables are included. Treatment options for direct‐acting antivirals (DAAs) have been updated and include the latest combinations of sofosbuvir/velpatasvir/voxilaprevir and glecaprevir/pibrentasvir. Recommendations on management of DAA failure and acute HCV infection have been expanded. For treatment of tuberculosis (TB), it is underlined that intermittent treatment is contraindicated, and for resistant TB new data suggest that using a three‐drug combination may be as effective as a five‐drug regimen, and may reduce treatment duration from 18‐24 to 6‐10 months.
Conclusions
Version 9.0 of the EACS Guidelines provides a holistic approach to HIV care and is translated into the six most commonly spoken languages.

11. Incidence of new hepatitis C virus infection is still increasing in French MSM living with HIV

AbstractPegylated interferon-alpha (pIFN-α) is suggested to lower HIV-1 DNA load in antiretroviral therapy (ART) treated patients. We studied the kinetics of total HIV-1 DNA levels in 40 HIV-1/hepatitis C (HCV) coinfected patients, treated with pIFN-α for HCV and categorized into three groups according to start of ART: Chronic HIV-1 infection (n=22), acute HIV-1 infection (n=8), no-ART (n=10). Total HIV-1 DNA levels were quantified in 247 PBMC samples and remained stable before, during, and after pIFN-α treatment in all three groups. Our study-results question the benefit of pIFN-α as an immunotherapeutic agent for reducing the HIV-1 reservoir.

14. Now is the Time to Quickly Eliminate Barriers along the Hepatitis C Cascade of Care

AbstractThere is growing evidence that hepatitis E virus (HEV) infection can present with extrahepatic manifestations including neurological disorders. Among these, neuralgic amyotrophy (NA) has been reported to occur in some industrialized countries. We investigated 35 patients with NA and a control group for markers of HEV infection. Acute HEV infection was found in NA patients only and was associated with an inflammatory response in the central nervous system. Shedding of HEV RNA into the cerebrospinal fluid and intrathecal production of anti-HEV IgM occurred in one patient suggesting that HEV is neurotropic.

Mother-to-child transmission of hepatitis B virus (HBV) accounts for the majority of cases of chronic HBV infection, a leading cause of cirrhosis and hepatocellular carcinoma worldwide. Without immunization, 30 to 42% of the infants born to HBV-infected mothers, depending on the maternal status for…

18. Twenty-Five Years of Lamivudine: Current and Future Use for the Treatment of HIV-1 Infection